- Molina Healthcare (Cleveland, OH)
- …experience, including hospital acute care/medical experience (STRONGLY DESIRED)** + **Registered Nurse with Claims and CIC coding experience (STRONGLY DESIRED)** ... **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as… more
- Lincoln Financial (Columbus, OH)
- …at a Glance** We are excited to bring on highly motivated Short Term Disability Claims Specialists to staff our ever-growing claims organization. As a Short Term ... home, then please read on! Click the following link Claims Specialist Job Preview (https://marketingmedia.lfg.com/lfg/DOCS/lfd/emailMarketing/Video/6369162297112.html) to see a realistic… more
- CVS Health (New Albany, OH)
- …including co-morbid and multiple diagnoses that impact functionality. - Reviews prior claims to address potential impact on current case management and eligibility. ... health needs based on key questions and conversation. **Required:** - A Registered Nurse that must hold an unrestricted license in their state of residence,… more
- Elevance Health (Mason, OH)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Sedgwick (Columbus, OH)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical and quality ... flexible spending or health savings account, and other additional voluntary benefits._ \# nurse Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.… more
- Molina Healthcare (Cincinnati, OH)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases ... of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of… more
- Elevance Health (Columbus, OH)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- Elevance Health (Mason, OH)
- **Transplant Nurse II** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... Wednesday - Sunday or Thursday - Monday. The **Transplant Nurse II** will be responsible for providing case and/or...treatment plans. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Elevance Health (Mason, OH)
- ** Nurse Case Manager II** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... an accommodation is granted as required by law._ The ** Nurse Case Manager II** will be responsible for care...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Sedgwick (Columbus, OH)
- …PURPOSE OF THE ROLE:** Investigate, analyze and evaluate medical malpractice claims to assess liability issues and exposure. Reviews medical records, interviews ... providers, prepares detailed medical summaries for defense counsel and claims professionals. **ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic… more